- Cognizant (Columbus, OH)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state)… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) Compact license, with no… more
- CVS Health (Columbus, OH)
- …Effective communication skills, both verbal and written **Required Qualifications** + 3+ years of clinical experience as a Registered Nurse in a hospital ... work schedules will include weekends, holidays, and evening hours._ + Utilizes clinical experience and skills in a collaborative process to assess, plan, implement,… more
- CVS Health (Columbus, OH)
- …hours available with Holiday, Weekend, and late rotations. **Required Qualifications** + Registered Nurse + Must have active current and unrestricted RN ... it all with heart, each and every day. **Position Summary** + Utilizes clinical experience and skills in a collaborative process to assess, plan, implement,… more
- Fresenius Medical Center (Columbus, OH)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Veterans Affairs, Veterans Health Administration (Columbus, OH)
- …for Community Care. Duty location is in Columbus, OH. The Referral Coordination Team - Registered Nurse (RN) ) is responsible and accountable for all elements of ... possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, ...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- Trinity Health (Columbus, OH)
- …+ Associates degree from an accredited RN program + Current license to practice as registered nurse in the State of Ohio + Minimum of 3-5 years recent ... This is done with the intentions of cost effective utilization of hospital resources, minimizing out of pocket expenses... clinical experience in an acute care setting. **This role… more
- Molina Healthcare (Columbus, OH)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support...hearings as may be required. * Serves as a clinical resource for utilization management, chief medical… more
- OhioHealth (Columbus, OH)
- …Heart Association, BLS - Basic Life Support - American Heart Association, RN - Registered Nurse - Ohio Board of Nursing **Additional Job Description:** Current ... careers and in our communities. **Job Description Summary:** The RN Clinical Leader provides leadership and coordinates the design, development, implementation and… more
- CenterWell (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... an impact** **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no...Lung or Critical Care Nursing experience required + Prior clinical experience preferably in an acute care, skilled or… more
- Humana (Columbus, OH)
- …help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation ... Facilities to obtain sufficient clinical information. The Utilization Management Behavioral Health Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) Compact license, with no… more
- Molina Healthcare (Columbus, OH)
- …and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse (RN). License must be active and unrestricted in ... for denial or modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider… more
- Sharecare (Columbus, OH)
- …to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they… more
- Molina Healthcare (Columbus, OH)
- …behavioral health, or equivalent combination of relevant education and experience. + Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed ... **Required Qualifications** + At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of… more
- Molina Healthcare (Columbus, OH)
- …education and experience. r equivalent combination of relevant education and experience. * Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed ... * Excellent organizational, problem-solving and critical-thinking skills. Preferred Qualifications * Registered Nurse (RN). License must be active and… more
- Molina Healthcare (Columbus, OH)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Molina Healthcare (Columbus, OH)
- For this position we are seeking a (RN) Registered Nurse who must be licensed for the state they reside This role will be doing Utilization review for our ... Ohio Medicaid population, looking for clinicians with strong inpatient clinical experience WORK SCHEDULE: Tuesday to Saturday - 8...or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active… more
- Molina Healthcare (Columbus, OH)
- …internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more